双眼上斜肌腱缝线延长术治疗A型斜视的远期临床疗效  

Long-term clinical effects of the bilateral superior oblique tendon suture spacer in the treatment of A-pattern strabismus

作　　者：高小琴 冯雪亮[1] 吴艳[1] 张丽军[1] 李俊红[1] 常敏[1] 孔淼[1] Gao Xiaoqin;Feng Xueliang;Wu Yan;Zhang Lijun;Li Junhong;Chang Min;Kong Miao(Shanxi Eye Hospital,Taiyuan 030002,China)

机构地区：[1]山西省眼科医院,太原030002

出　　处：《中华眼科杂志》2020年第11期853-858,共6页Chinese Journal of Ophthalmology

基　　金：山西省科学技术厅自然科学基金(201801D121295)。

摘　　要：目的探讨双眼上斜肌腱缝线延长术治疗伴上斜肌亢进(SOOA)的A型斜视的远期临床效果及安全性。方法回顾性系列病例研究。收集2009年1月至2017年8月因A型斜视在山西省眼科医院行双眼上斜肌腱缝线延长术且随访资料完整的患者21例(排除单眼SOOA的A型斜视、Brown综合征和Helveston综合征),其中A型外斜视19例,A型内斜视2例;男性11例,女性10例,年龄(14±9)岁。对手术前后A征的大小、眼球客观旋转程度、SOOA程度以及双眼视觉进行比较。统计学分析采用配对t检验、Wilcoxon秩和检验、Spearman秩相关检验及简单线性回归分析。结果术后随访时间为(26±17)个月(12~109个月),20例患者水平斜视经1次手术矫正至正位,水平斜视度数在±10三棱镜度(PD)之内;1例内斜视患者术后水平斜视度数>+15 PD。21例患者A征均消失,由术前(23.81±9.47)PD矫正为(0.90±3.59)PD(t=11.29,P<0.01),矫正量为(23.52±9.68)PD。眼球客观旋转度数术前为3.18°±3.26°,术后为-4.81°±4.13°,术前、术后差异有统计学意义(t=8.87,P<0.01),旋转矫正量为7.95°±3.88°,无一例患者出现旋转复视。42只眼术前、术后SOOA程度[中位数(四分位数间距)]分别为3.0(2.0)、0.0(1.0)级,差异有统计学意义(Z=-5.78,P<0.01)。Spearman相关性分析显示,上斜肌腱缝线实际延长量与术前SOOA程度有相关性(r=0.47,P<0.01),但与术前眼球客观旋转程度无相关性(P=0.88)。线性回归分析结果为缝线延长量=2.71×术前SOOA程度(t=27.93,P<0.01)。结论双眼上斜肌腱缝线延长对A征、眼球内旋及SOOA有明显改善,远期无旋转复视及V征的发生,是一种安全、有效的上斜肌减弱方法。Objective To investigate the long-term clinical efficacy and safety of the bilateral superior oblique tendon suture spacer in treatment of A-pattern strabismus with superior oblique overaction(SOOA).Methods Retrospective case series study.Twenty-one A-pattern strabismus patients who received the quantitative bilateral superior oblique tendon suture spacer with a complete follow-up from January 2009 to August 2017 were enrolled.Among these patients,19 were exotropic and 2 were esotropic,including 11 males and 10 females,aged(14±9)years.Patients with unilateral superior oblique overaction,Broun syndrome or Helveston syndrome were excluded.The A-pattern strabismus,objective torsion,function of the superior oblique muscle and binocular vision were examined pre-and post-operatively.Paired t-test was used for normal distribution data,Wilcoxon rank-sum test was used for non-normal distribution data,Spearman rank correlation test and simple linear regression were used to analyze the correlation between the two variables.Results The follow-up was 12 to 109 months(mean,26±17 months).Twenty patients showed good alignment in the primary position with a deviation angle less than 10 prism diopter(PD),and 1 patient with esotropia had an angle greater than 15 PD.All the patients had no A pattern after surgery.The average pre-and post-operative A-patterns were(23.81±9.47)PD and(0.90±3.59)PD(t=11.29,P<0.01),respectively,and the average corrected A pattern was(23.52±9.68)PD.The average pre-and post-operative torsion was 3.18°±3.26°and-4.81°±4.13°(t=8.87,P<0.01),espectively,and the average corrected torsion was 7.95°±3.88°.No patient complained of torsional diplopia after surgery.The average amount of pre-and post-operative SOOA was 3.0(2.0)and 0.0(1.0)in 42 eyes(Z=-5.78,P<0.01),respectively.Suture extension of the superior oblique tendon was related with the pre-operative SOOA(r=0.47,P<0.01),but was not related with the pre-operative torsion(r=0.02,P=0.88).The linear regression results was suture extension=2.71×the g

关 键 词：斜视 眼外科手术 A型斜视 上斜肌 肌腱缝线延长 

分 类 号：R779.6[医药卫生—眼科]